ArticleThe American journal of clinical nutrition2026
Optimal measures of carbohydrate quality to lower the risk of type 2 diabetes: findings from 3 prospective cohort studies.
Article in The American journal of clinical nutrition, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundNumerous carbohydrate quality metrics (CQMs) have been suggested, yet the optimal one(s) associated with the lowest type 2 diabetes (T2D) risk remains unknown.
objectivesWe aimed to systematically compare 23 CQMs with T2D risk, identify the 5 strongest associations, propose an alternate Carbohydrate Quality Index (aCQI), and compare it with the existing CQI regarding T2D risk and cardiometabolic biomarkers.
methodsWe included participants of 3 prospective cohort studies [Nurses' Health Study I (1984-2020) and II (1991-2019), and Health Professionals Follow-up Study (1986-2020)], who were free of cancer, diabetes, and cardiovascular disease. Our primary outcome was incident T2D. We examined 13 plasma biomarkers in relation to CQIs among a subset.
resultsDuring 5,628,955 person-years of follow-up among 213,704 adults, 22,351 cases of incident T2D were ascertained. In multivariable-adjusted models, comparing Q5 to Q1, intakes of cereal fiber [relative risk (RR): 0.77 (0.74-0.81)], whole-fruit carbohydrates [RR: 0.80 (0.76-0.84)], glycemic index [RR: 1.20 (1.14-1.26)], sugar from sugar-sweetened beverages [RR: 1.22 (1.17-1.28)], and whole-grain carbohydrates [RR: 0.86 (0.82-0.91)] had the strongest associations with T2D risk. The aCQI [RR: 0.71 (0.68-0.75)], comprising these variables, had a larger magnitude of association with T2D risk than the original CQI [RR: 0.82 (0.79-0.87)], which included total fiber intake, glycemic index, the ratios of whole to total grains, and solid to total carbohydrates. The aCQI had significant associations with a larger percentage of differences in cardiometabolic biomarker concentrations, such as C-peptide, leptin, and LDL cholesterol, than the CQI (all P-trend ≤ 0.001).
conclusionsThe novel aCQI, comprised carbohydrates from whole fruits, whole grains, sugar-sweetened beverages, cereal fiber, and glycemic index, was more strongly associated with risk of T2D and cardiometabolic biomarkers than its individual components or the existing CQI, necessitating further research.
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